My Breaking Point!

[tn nurse]

Hi there, I recently had a run in (again) with being called into the office to discuss why I, the nurse, walked into a patients room. Really, that is exactly how it was stated. I am the nurse on the floor, by the way, the only nurse here at that time and I was handing out meds, the aide on the floor went to my super. and said I was going behind her back, I about fell out of my chair. I explained that I am a nurse and I am doing my job and I was giving that particular person meds required. So, really, is this crazy to even be asked this? I ended up crying in the office, I am so over aides continually, same ones, going into the office and saying I talk to them as if I am over them etc., and the way I come across is a problem. I totally believe I am in the right here. I have had some past issues but yet, I have overcome them and am laid back as my employer requested of me. Now I am really truly feeling like I am being harrassed by the caregivers. See, before me was a nurse that was everyone's friend, and didn't care what they did, no longer employed there, here I am and I have to ask the aides for things, and what I usually will say is something like this, "when you get a chance could you go get ice water for ....." or "if you need help let me know"...this is what I say, and am polite. I am being shoved under the bus and have no idea how to deal with this because management is the ones that even asked why I was entering a room...okay, so I am a nurse right, so my mgmt tells me to leave my aides alone and not get in their way, well, okay, and I am told if I need something from them write it down and we'll (mgmt) will discuss it the next day...okay, this only works if nothing is needed that night....hello? these people ask for things on a continual basis so that is kinda hard to do too. Am I just being overly sensitive to this or what? I ended up being so fed up with lies about me, aides saying I said somethings when nothings were said, or an aide taking it the wrong way because they were not in the conversation. What to do? I need your help other LPN's!

[Dafabb, LPN]

I am a 35 yr LVN and have worked 6/8 yrs in NH. One thing I have never doubted is the CNAs are very over worked. They are also the backbone of any Hospital/Nursing Home. You will find burned out CNAs and those are the most dangerous. I also make it a common place to do everything they do as often as I can to help them. In that way they can not say you do not help them. If you empty a foley or 5 on your way down the hall make a note. If there is a difficult resident(heavy/contractures) offer to help with that one. Be prepared for beligerance. They might think you believe they can't do it. 2 people can do 1 thing quicker and easier. Anything you do they have to keep up with, make a note. Then take it to your CNA and tell them they do not have to do these and give them the list to put it on the I/O sheet. Make a second copy if you do not trust them.(date included) When you speak to them don't converse. Do it sweetly. When you are in charge you are the final decision if they have a problem. If you are actually the even/night Sup then you are in charge. But do it gently. It sounds like the Sup. job is on paper only if you are in charge of a unit. I was also the 3-11 sup.for a 400 bed NH. Only a hand full of my time did I have to work a unit. I loved all my girls and they really liked me from the RNs to CNAs. And I respected each and every one. They never like to break in a new nurse but the kinder you are with being in charge the easier it will get. If it does not find another job and secure it and give your 2 week notice.

[bestallaround, ADN, CNA, LPN, RN]

I feel for you tn, I have seen nurses get crucified by NA staff, but Brandon is right. You really have to present yourself as part of the team. Yes, you are their supervisor. Yes, you are the boss. You don't think they know that? I was an NA for about 18months before getting my LPN and I did not need anyone to supervise me. I knew my job, I knew what had to be done. Thing is, NAs, just like LPNs, have a routine. Let them do their job, and stay out of their way. If management is sticking up for them, they must be doing something right.

[morte, LPN, LVN]

90-95% correct, but someone needs to "see" to do an eval. I know the place were i work, the sup has to see the aide do a particular task. Most aides i work with don't need a "keeper" but occassionally we all need feed back.

Trust me, aides don't respect nurses who go behind them and inspect their work. If an aide is doing a lousy job, it's obvious without having to go behind them. My aides trust me because I treat them as equal partners. They can count on me to have their backs. When I ask them to do something they do it BECAUSE I don't treat them like children who have to be followed up on. These are grown-a** women who've been doing this job years before I became a nurse. They know what they're doing.

[jadelpn, LPN, EMT-B]

BUT CYA and don't risk your license. If they are NOT doing what they should be, then it is a concern. If at the end of your shift (or near the end) you see that things are not done and it could be dangerous for the patient, then do it. It takes but one out of control decubitus and "I left them alone to do their job" will not cut it when your license is on the line. Most CNA's know their job and know their patients. But your job as a supervisor needs to be sure that they follow through. Management has a tricky way sometimes of "well, I NEVER said that she should just leave the aides alone" when something goes wrong.

[BrandonLPN, LPN]

All good points, but there are ways to monitor residents' care without making it look like you're following up behind them. Honestly, I've never witnessed one of my aides do anything that concerned me. Are some of them slow in passing out snacks? Is there some laziness sometimes? Well, yes, of course. Would me making a "thing" of it help? No, it'd only make things worse. I've seen it before....

[morte, LPN, LVN]

THIS! Management wants to hear no complaints from anyone. Which of course is not realistic. I have seen more than one unit that the aides "ran". and "ran" off the nurse hired to straighten it out! Respect and friendship do not go hand and hand in this situation. I wouldn't dream of running a lift without an aide (not another nurse, an aide) because i know they know what they are doing. But I frequently offer to spot or push the button, just be ready to go when i get there, lol. I never was an aide, but i went to a hospital school of nursing, so yes, I know the business end of a wash clothe, and help out there as well. But the important thing to remember: We, the nurses can legally do the aide job, they can't do ours. And management doesn't want to hear med pass was late because you were giving someone a bath/shower etc.

BUT CYA and don't risk your license. If they are NOT doing what they should be, then it is a concern. If at the end of your shift (or near the end) you see that things are not done and it could be dangerous for the patient, then do it. It takes but one out of control decubitus and "I left them alone to do their job" will not cut it when your license is on the line. Most CNA's know their job and know their patients. But your job as a supervisor needs to be sure that they follow through. Management has a tricky way sometimes of "well, I NEVER said that she should just leave the aides alone" when something goes wrong.

[morte, LPN, LVN]

If that is a chronic issue, it needs addressing. A "come here a minute" i want to ask you something....no need to call them out in front of their peers. Though, their peers are probably well aware, lol. I don't take kindly to public correction, I don't inflict it on others. In the OP, the nurse was going in the room to give a med, should she have not done that, perhaps waiting a little while so that it did't look like she was "going behind" the aide? don't think so.

All good points, but there are ways to monitor residents' care without making it look like you're following up behind them. Honestly, I've never witnessed one of my aides do anything that concerned me. Are some of them slow in passing out snacks? Is there some laziness sometimes? Well, yes, of course. Would me making a "thing" of it help? No, it'd only make things worse. I've seen it before....

[MedChica]

I've recently worked with some problem aides and the situation actually resolved itself when they quit.

(I am an aide, btw).

They complained too much and we were always having 'Come to Jesus' meetings because of it with management. The DON.

Well - the pooh hit the fan and the new charge RN (4 mths out of nursing school, mind you) hit the ceiling. She showed everyone 'who doesn't want to be here', the door. They left soon after. Honestly, the rest of us only miss the presence of one. The other two were just dead weight.

I used to be annoyed that the nurses saw but just let the one girl do as she would. If we can see it, why can't they? Who all is doing the work and who all is letting others pick up the slack?

The nurses were too friendly with them, in my opinion and when you blur the lines? It's difficult to lead with authority. They don't take it seriously. Boundaries must be firm and can't really happen with some personalities...when you're hanging out every weekend.

I was also annoyed that these stupid women couldn't handle things themselves. That's why we had so many 'Come to Jesus' meetings because these damned whiny hags acted as though they didn't understand how to solve issues at the lowest level.

Honestly, I've managed a dept aand supervised before...but I never considered this sort of hat for nursing until recently.

This situation has somewhat soured me to the idea of managing as a nurse.

I'm 'over' aides, too...and I am an aide. LOL

I'm a 'self-hating CNA'. LOL

You can have what has the potential of being a good crew, but there's always 2 or 3 in the bunch that throws everything off.

I'm task-oriented to begin with and I don't do well with the lazy.

That's going to be my challenge, I know.

I'm not going to blame you on this. I can easily see where it may not be your fault.

Some people cannot handle direction

Some aides have an inferiority complex. During one of the meetings, one of the ex-aides pulled the whole 'we're-talked-down-to-the-nurses-speak-as-though-they're-above-us' card. The rest of the aides, including myself, just looked at her.

As usual. She had the floor and the bulk of us didn't know what was going on...or why we were in a meeting to begin with.

Some people cannot handle criticism...or being led.

Nurse: "Hey - when you get the chance, can you -- "

Aide: "Why do I have to do that...?" and "Why can't -- " There's sucking of teeth and sighing under the breath.

Although...sometimes?

I think the thing that gets me the most about our nurses? They aren't aware of or looking at the whole issue before they start questoning in a demanding way.

We'll have a situation where this or that person will call in and, of course, we won't know that we have to do another hall because that aide isn' coming until the last minute. We're hauling ass and powerlifting residents. By 10 minutes after, everyone's dressed and in the dining hall.

But what do the nurses pay attention to? The fact that the beds aren't made.

Really?

The fact that's it's 5 minutes after and we're still taking residents to the dining hall. 'Why isn't everyone in the cafeteria?!'

Seriously? We were just told 10 minutes ago because the stupid nightshift nurse doesnt' know how to relay a message! Obviously...because you seem unaware, too!

When aides get slammed. Yeah - they'll lash out. LOL Not necessarily at the nurse. Just because there's one more task when they're running around with their heads chopped off. Even me. I'll sigh, but it's nothing to do with the nurses. I'll apologize aftrward. The work is hard and can be very overwhelming. A lot of times, we work understaffed.

Once there were 4 of us and the nurses decided to 'bomb' everyone.

Seriously?!

No heads up or nothing. One little guy, this aide and I helped a new girl change/clean 3 times within 30 or so minutes...and the bed was on FLOOR! So, not only did it kill my back...it threw me off on my individual floor...because I still had people to put down. I had 4 heavy duty pee-ers to get to ASAP and if I didn't hurry? Those beds were going to be soaked which equates to more work. Last thing I wanted was to strip an occupied bed...which is precisely what I ended up doing.

I had 20 rooms and there were 2 pts in every room and half are total assist. Slightly more are incontinent.

You do the math.

Oh, yeah - our nurses got MAJOR 'tude that day/night from everyone...because one was still on this 'do' this and 'do' that jazz. She laughed about the situation, too. On a good day, we would've joined in, but since we were doing the work? Wasn't funny. Though, i'm sure that it would've been as funny had the aides just quit and that nurse had to do that work all by themselves.

Hilarious.

[BrandonLPN, LPN]

What's a 'Come to Jesus' meeting?

[Fiona59]

What's a 'Come to Jesus' meeting?

Up here in the Great White North, it's when the feces hits the fan and you have to own up to your transgressions. Aka: shape up or ship out